Postpartum depression: When the bough breaks

Joanne Laucius, Postmedia News11.02.2011

One in five mothers -- and one in 10 new fathers -- will suffer from postpartum depression, says Dr. Jasmine Gandhi, an assistant professor of psychiatry at the University of Ottawa and a psychiatrist with the perinatal mental health clinic at the Ottawa Hospital.

Looking at Erin Westelman, you wouldn’t know the 34-year old mother of two hasn’t had a complete night’s sleep since her son was born...

Esme Andersson knows depression. It is the beast that has stalked her since she was 17 years old. "I didn’t recognize it for what it was," says Andersson, now 36, a public servant and the mother of two.

"Because it is so gradual, you’re losing the colours of life. Your emotions become muted. Then one day you realize how far you have fallen down this well."

Andersson was lucky. Her mother recognized the condition, and Andersson got a prescription for the anti-depressant Zoloft.

Things improved. She dropped the anti-depressant, then started taking it again as episodes of depression dogged her throughout her adult life.

A new, deeper cycle of depression started after Andersson’s first baby died shortly after her birth in 2007. Andersson was still mourning her daughter’s death when she became pregnant again four months later.

Andersson’s second baby, a boy, had colic for seven months. "I thought I was justifiably stressed," she says.

Her third pregnancy — the third in three years — was difficult. She learned that her baby would have to be born by caesarean section and she feared, irrationally, that she would die in the process.

She was referred to the perinatal mental health clinic at the Ottawa Hospital after she broke down in tears when she met the obstetrician to schedule the surgery.

"I kept asking if I had to write my will. I guess that raised some red flags," she says.

Half of all new mothers will get a case of the "baby blues," a feeling of being sad and overwhelmed. That usually lingers a few weeks. However, one in five mothers — and one in 10 new fathers — will suffer from postpartum depression, says Dr. Jasmine Gandhi, an assistant professor of psychiatry at the University of Ottawa and a psychiatrist with the clinic.

Gandhi and her colleagues at The Ottawa Hospital see 400 to 500 cases of depression in pregnant and postpartum women every year, all referred by physicians. However, it is estimated that there are 1,500 such cases across Eastern Ontario in the course of a year and only about a third are getting treatment.

Those who seek treatment are more likely to be educated, relatively affluent, white and English-speaking. Gandhi says there are cultural sensitivities around the issue. Women hesitate to seek help because of the stigma, because they fear they will be reported to child protection authorities and because they don’t have child care or the time and money to get help.

"This is not a disease that discriminates. These are usually healthy women," says Gandhi.

Maternal depression is not usually a topic that comes up at baby clinics.

"Everyone is talking about feeding issues and immunizations, not ’I don’t even have the energy to get up in the morning.’"

In 2000, Suzanne Killinger-Johnson, a physician and psychotherapist who specialized in depression, died when she jumped in front of a subway train in Toronto with her six-month-old son Cuyler in her arms.

Killinger-Johnson had fallen into a postpartum depression and attempted suicide. She was under a 24-hour watch and left her home with the baby when a relative went to the washroom.

This widely reported incident was a case of postpartum psychosis, which affects only one or two out of every 1,000 new mothers. Garden-variety depression is more common, affecting about 20 per cent of new mothers, says Gandhi.

"These women feel low. They have no energy. They feel like they are walking through molasses. Sometime they feel like walking away from their baby."

This is also an illness with a million faces, says Andersson. To others, she did not appear sad, but rather irritable and even aggressive.

"It reduces you to a primal state. You’re like a wild animal backed into a corner. You see hurt and harm where there isn’t any," she says. "You want to hide."

The illness can have health effects that go far beyond a few weeks of feeling blue, says Gandhi. Women who are depressed aren’t sleeping or eating well, and this stresses the body. It can trigger a predisposition to heart disease and stroke.

Babies born to depressed women can have a lower birth weight. They may also be slower in reaching developmental milestones and are more likely to be prone to behavioural problems and mood disorders later in life.

Depression may also manifest as an eating disorder. "I see women who are bingeing and purging right up to the time they deliver," says Gandhi.

Depression can also affect the children who already live in the home.

A provoking two-or three-year-old can bear the brunt of the mother’s irritability. Depression is also damaging to marital relationships.

Andersson attended Gandhi’s group therapy sessions reluctantly, knowing that she would break down in tears in front of strangers. "I hate crying in front of other people," she says.

The women in the sessions brought their babies with them. Many of the women appeared warm and happy on the outside. "I thought, ’She’s wearing a mask.’ Most of us were barely functioning. You wear a mask because you have to. You get up in the morning because you have to. You put on a sunny disposition because life couldn’t be more bleak."

At her first session, Andersson noticed a common thread among the women.

"We’re all trying to do it all. We were trying to be perfect mothers and perfect wives. You can’t have friends over because there are dirty dishes in the sink."

Andersson’s 16 sessions of therapy taught her that there are worse things than dirty dishes and crying in front of strangers. She has learned to open up and ask for help from her husband, family and co-workers when she feels overwhelmed.

"There are a lot of us out there," she says. "There is hope. Really, the best thing is to acknowledge that it’s OK to feel like this."

Gandhi says medication and psychotherapy are effective in some cases, but there are other possible solutions. In one Toronto pilot project, women with postpartum depression got telephone support from other women who had previously suffered from depression. The program reduced the chances of a major depression.

Another trial project concluded that five consecutive hours of sleep every night is a reliable antidote to depression, allowing for two cycles of rapid-eye-movement sleep.

Informal circles of support are also valuable, says Gandhi. Today, many women find themselves stranded during their year of maternity leave and have to create that network.

Andersson is back on anti-depressants and may be for life. She is not happy about that, but it is better than the alternative.

"In my head, it’s depression with a capital D," she says. "I consider it a beast or a demon. It’s like a dark shadow that is always with me."

The group therapy sessions have given Andersson insight into herself. She knows that depression has to be managed on an ongoing basis. Occasionally, the bottom will fall out. To her, the world is like a sheet of white paper with a black spot on it. Her eye will always focus on the spot.

"I take it as I can and try to anticipate it," she says.

The first step for new mothers is to accept that there is no such thing as superwoman or supermom. Sometimes you need help, says Gandhi.

"It’s the hormones. So get it treated."

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